Healthcare Provider Details

I. General information

NPI: 1477755650
Provider Name (Legal Business Name): RIVERSIDE RETIREMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 W MERCURY BLVD
HAMPTON VA
23666-3729
US

IV. Provider business mailing address

1020 OLD DENBIGH BLVD
NEWPORT NEWS VA
23602-2017
US

V. Phone/Fax

Practice location:
  • Phone: 757-251-7977
  • Fax: 757-251-7985
Mailing address:
  • Phone: 757-875-2050
  • Fax: 757-875-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: CRAIG CONNORS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-875-2050